Individual Course Approval Form

MECKLENBURG COUNTY PUBLIC SCHOOLS
Master's Reimbursement Program

Individual Course Approval Form

I plan to enroll in the course listed below and seek reimbursement through my approved Master's Program.

* Name of Course:

* Course Number:

Course Dates:

* Starting Date

* Ending Date:

* College/University:

* Tuition Amount Due:

In order to receive reimbursement, I understand that the following items must be completed.

1. Obtain Prior Approval for this course (this form)

2. Submit Reimbursement Form and all necessary attachments

* Social Security Number:

* Base School:

* Employee Signature:

* Date:

Typing your name in the space above serves as your signature.

* Home Address:

Do not Complete the Information Below:
Central Office Department of Instruction Use Only

Approval Status:

Yes

Assistant Superintendent

Date:

Reason(s) for denial:

* Indicates Response Required

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